The Advantage of Leveraging AI for Improved Life Claim Processing

Much like underwriting, historically, the life claim review process is often overwhelmed by vast volumes of data and documents requiring claim professionals to sift through extensive medical records to review contestable claims. This laborious and time-consuming process often consumes claim professionals' valuable time and hinders the ability to conduct comprehensive medical record reviews. Consequently, this may delay payment of legitimate claims and lead to material misrepresentations and undetected fraud.

Claims Satisfaction is Critical for an Insurer’s Success

Efficiently settling life claims enables insurers to provide grieving families with essential financial support during a deeply challenging time. Amid the stress and uncertainty that often accompanies such personal loss, prompt resolution of these claims helps alleviate the financial burden, including assisting families with immediate expenses such as funeral costs and outstanding debts. Longer term, payment of claims allows families to maintain their standard of living and secure their financial future. The prompt handling of life claims therefore offers emotional relief and practical support while helping families focus on healing and adjusting to their new circumstances.

Efficiency is a critical aspect of the client claim experience. Modern consumers have higher expectations than ever when it comes to the speed, accuracy, and personalization of services. In fact, a recent study by accounting company EY found that 87% of customers say claims processing effectiveness influences their decision to renew their insurance policy with the same insurer. Taking it a step further, a positive experience could also increase the potential for an insurer to retain policy beneficiaries as customers and retain the related financial assets and investments. The benefits of increased efficiencies include potential savings to insurers by decreasing the amount of postmortem interest payable.

According to EY’s “Claims in the Digital Era” report: “In the low-touch relationship between consumers and their insurance companies, claims handling may represent the most important and meaningful interactions.”

When claims processing is well executed, insurers pay legitimate claims quickly and identify material misrepresentation and fraudulent claims with confidence and transparency. The following are common stumbling blocks within traditional claims processing:

• Inefficient, time-consuming tasks
• High administrative cost
• Error-prone processes
• Frequent delays
• Bottlenecks from lack of centralized information

These factors can increase the time to pay legitimate claims and negatively impact customer satisfaction and retention.

“RGA’s vision is to revolutionize the operational efficiency of claim operations, as well as enhance the customer experience for the policyholders of our clients,” said Curtis McAdams, Vice-President of Claims & Operations Service Center at RGA. “Clients who utilize DigitalOwl’s ability to create a concise, easy-to-read summary of voluminous medical documents can expect to enhance their customer’s experience by expediting claim decisions and more effectively conducting post-claim decision quality audits. RGA clients can look forward to increasing innovative applications arising from its partnership with DigitalOwl to also identify other claim related risk, such as undisclosed vocational, recreational, and travel risk, as well as potential fraud.”  

Using DigitalOwl’s AI Solutions for Life Insurance

Powered by a trio of cutting-edge technologies, DigitalOwl is transforming life claims reviews. Consider the following ways DigitalOwl’s products can enhance the claim process:

• Surface critical details: DigitalOwl’s algorithms efficiently analyze large volumes of data, identifying crucial information and potential material misrepresentations. This ensures that insurers have access to relevant details for informed decision-making.
• Standardize and structure data: By structuring data, our AI systems streamline the review process, reducing the time needed to evaluate claims and improving time-to-client. Standardized data also facilitates easier identification of key details that may be overlooked by underwriters or claims professionals.
• Capture key details: Our systems leverage advanced algorithms to create concise and accurate medical record summaries, ensuring that vital details within extensive documents are captured and analyzed.
• Speed claim review: Our business solutions reduce the time required for the medical review process by up to 72%. This expedites claim evaluations, leading to faster resolutions for claimants.
• Improve accuracy: DigitalOwl’s technologies boast precision rates of 97% or higher, minimizing the risk of errors and ensuring that no critical information is overlooked during the review process.

Detecting Consumer Misrepresentation with AI

Our business solutions meticulously capture inconsistencies and misrepresentations, promptly bringing them to the attention of underwriters and claim professionals. This heightened scrutiny not only enhances accuracy but also streamlines the review process, saving valuable time. By swiftly identifying potential material misrepresentations within the contestable period, insurers can mitigate the risk of unjustly paying claims based on misleading information while reducing the risk of delaying payment on legitimate claims.

Conclusion

Leveraging DigitalOwl’s tool for insurance claims processing can streamline operations, enhance accuracy, and help insurers provide timely and compassionate support to claimants during one of the most difficult and emotional times of their lives. DigitalOwl’s innovative business solutions allow insurers to review claims with greater speed and accuracy, ultimately contributing to greater trust, satisfaction, and loyalty among policyholders.

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